Provider Demographics
NPI:1669590246
Name:VIVIANO, MARYANNE ELIZABETH (NYS LIC MASSAGE THER)
Entity type:Individual
Prefix:MS
First Name:MARYANNE
Middle Name:ELIZABETH
Last Name:VIVIANO
Suffix:
Gender:F
Credentials:NYS LIC MASSAGE THER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 BAYSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701
Mailing Address - Country:US
Mailing Address - Phone:516-445-6295
Mailing Address - Fax:
Practice Address - Street 1:390 MERRICK AVE
Practice Address - Street 2:OFFICE
Practice Address - City:EASTMEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554
Practice Address - Country:US
Practice Address - Phone:516-489-2212
Practice Address - Fax:516-489-5132
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006367225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist